Biomedical subjects
Publications and source records attributed to M K Mohapatra.
For reasons unknown, the association of diabetes mellitus with sickle cell anaemia is uncommon. A patient of sickle cell anaemia with diabetes mellitus, complicated with ketoacidosis is being reported in view of its rarity.
Demyelination may be a pathogenic mechanism of post-malarial neurological sequelae. It can cause pseudobulbar palsy, which has not been documented earlier. In the present communication we report two cases of pseudobulbar palsy after cerebral malaria with evidence of demyelination.
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OBJECTIVES: The study was conducted in two parts to find out the usefulness of hypohaptoglobinemia (Hpo) as a biochemical and epidemiological marker of malaria. Part-I study was conducted in a Medical College Hospital to find out Hpo in malaria and the time required for normalization of Hpo. Part-II study was undertaken in two endemic areas of malaria to find out the prevalence of Hpo and haptoglobin index (HI) throughout the year along with other indicators of malaria. METHODS: In Part-I study, 172 patients of malaria constituting 58, 52 and 62 patients of cerebral malaria, uncomplicated falciparum malaria and vivax malaria, respectively were enrolled. Along with routine haematological and biochemical investigations, haptoglobin (Hp) estimation was done by endoplate haptoglobin test kit on admission and at 15 days interval for 3 months. In Part-II study Hp was estimated is 305 subjects in two endemic areas of malaria. HI, parasitic index, slide positivity rate (SPR), slide falciparum rate (SFR) were estimated throughout the year and HI was compared with these epidemiological markers. RESULTS: Hpo was present in 102 (92.7%) cases of falciparum malaria which was significantly more than vivax malaria and non-malarial fever. The normalisation of Hpo took about a month or more. The incidence of Hpo was 32.1% is endemic and 4.7% in nonendemic area of malaria. The HI varied between 12.4 to 25.2% throughout the year and was found to be a better marker than other classical markers of malaria. CONCLUSION: Hypohaptoglobinemia may be considered as a useful indirect indicator of falciparum malaria. HI can be used as an epidemiological maker which is better than classical markers of malaria used at present.
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Twenty two patients of subacute hepatic failure (SAHF), diagnosed when jaundice progressed for more than 8 weeks with appearance of ascites, with or without encephalopathy, along with biochemical evidence of hepatocellular damage, were studied. The male and female ratio was 4.5:1 and majority (45.4%) of cases were between the age group of 41-50. The mean biochemical values were: S.bilirubin; 9.2 +/- 3.8 mg/dl SGOT; 94.4 +/- 25.0 I.U./lit., SGPT; 107.8 +/- 32.7 I.U./lit., S.Protein; 5.2 +/- 3.5 secs. Ascitic fluid analysis showed transudate in 16 (72.7%) and exudate in 6 (27.2%) patients. Bacterial peritonitis was found in 5 (22.7%) patients. Liver biopsy showed bridging and submassive necrosis. The complications developed in the hospital were: renal failure (36.3%), infection (27.2%), G.I. bleeding (18.1%) and encephalopathy (13.6%). The mortality was (86.3%). Out of 3 (13.6%) patients who survived, only two recovered completely and one had biochemical evidence of hepatocellular necrosis after 6 months of follow up.
Clinical observations on toxicity after ingestion of gall bladder of Labeo rohita, a freshwater fish found commonly in India, were recorded from 22 patients between 1985 to 1990. The gall bladder in raw, cooked or desiccated form was swallowed as a traditional method of treatment for various chronic diseases. Patients generally presented with gastrointestinal symptoms such as cramping pain, nausea and vomiting within 12 hours (mean 4.6 +/- 3.7 hours) after ingestion. Subsequently renal failure was observed in all and hepatic dysfunction in some (36.3%) patients. The outcome in general is good. From the clinical course the role of toxic substance(s) is presumed as the causative factor(s), which needs further evaluation.
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Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.
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To study the extent of serum lipid peroxidation in malaria, 62 patients of falciparum malaria (18 uncomplicated and 44 complicated), 15 patients of vivax malaria and 25 healthy controls were enrolled in this study. The extent of serum lipid peroxidation was evaluated by estimating serum thiobarbituric acid reactive substances (TBARS) colorimetrically. The mean serum TBARS levels were 1.5 +/- 0.29, 1.21 +/- 0.2 and 3.58 +/- 1.35 nmol/ml in controls, vivax malaria and falciparum malaria patients respectively. The TBARS level was significantly more in complicated falciparum malaria patients (4.2 +/- 1.03 nmol/ml) than uncomplicated falciparum malaria patients (2.01 +/- 0.61 nmol/ml). The TBARS level was also more in patients who died (4.82 +/- 0.64 nmol/ml) when compared to the survivors (2.92 +/- 1.05 nmol/ml).
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About 110 patients were enrolled to study the atypical presentations and the chloroquine sensitivity pattern of Plasmodium vivax malaria. The diagnosis was made from Giemsa stained peripheral blood smear. The co-infection of falciparum malaria was excluded both by smear and ParaSight F-test. After a thorough clinical work up, biochemical investigations were done. The fever clearance and parasite clearance time were determined in all cases. Absence of malarial paroxysm (22.8 per cent), migrainous headache (4.5 per cent), myalgia (6.3 per cent), episodic urticarial rash (1.8 per cent), relative bradycardia (13.6 per cent) and postural hypotension (2.7 per cent) were the atypical manifestations encountered. Besides this, severe forms like jaundice (7.2 per cent), cerebral involvement (0.9 per cent), severe anaemia (7.2 per cent), thrombocytopenia (3.6 per cent) and pancytopenia (0.9 per cent) had been detected. All, except the patient with cerebral involvement were treated with chloroquine patients responded well to the treatment except two (1.8 per cent) patients who had chloroquine resistance. This study showed that vivax malaria can present with atypical and protean manifestations. The changing clinical profile along with development of chloroquine resistance may be considered as a warning signal.